Reverse innovation in maternal health

Authors

Kara A. Nerenberg, Division of General Internal Medicine, Departments of Medicine, Obstetrics and Gynecology, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: kara.nerenberg@ucalgary.ca.
Kelly B. Zarnke, O'Brien Institute for Public Health and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Alexander A. Leung, Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Kaberi Dasgupta, Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Sonia Butalia, Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada.
Kerry McBrien, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Kevin C. Harris, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Meranda Nakhla, Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.

Document Type

Article

Publication Title

The Canadian journal of cardiology

Abstract

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.

First Page

506

Last Page

525

DOI

10.1016/j.cjca.2018.02.022

Publication Date

5-1-2018

Recommended Citation

Nerenberg, Kara A.; Zarnke, Kelly B.; Leung, Alexander A.; Dasgupta, Kaberi; Butalia, Sonia; McBrien, Kerry; Harris, Kevin C.; and Nakhla, Meranda, "Reverse innovation in maternal health" (2018). Internal Medicine. 139.
https://scholar.bridgeporthospital.org/internal_medicine/139

Identifier

29731013 (pubmed); 10.1016/j.cjca.2018.02.022 (doi); S0828-282X(18)30183-1 (pii)